Sex-specific differences and diagnostic tool performance in the neuropsychiatric profile of Parkinson's disease

Neuropsychiatric symptoms are prevalent in Parkinson's disease (PD) but remain incompletely characterized, particularly concerning sex-specific differences and the comparative performance of diagnostic tools. This study aimed to provide a comprehensive neuropsychiatric profile of a Taiwanese PD cohort, evaluate the diagnostic sensitivity of various assessment tools, and explore correlations with clinical features.

We enrolled 92 PD patients and 57 healthy controls. Participants underwent a comprehensive assessment battery, including motor scales, cognitive measures, and mood inventories. Diagnoses of dementia and depression were established using standard criteria. Diagnostic tool performance was evaluated by calculating the sensitivity and specificity, and relationships between variables were assessed using Spearman correlation.

Dementia was identified in 34.8% and depression in 28.3% of PD patients. Female patients had lower scores on the Mini-Mental State Examination (MMSE) (25.18 vs. 28.08, p = 0.003) and Montreal Cognitive Assessment (MoCA) (21.18 vs. 25.79, p = 0.001), and higher scores on the Hamilton Depression Rating Scale (HAM-D) (6.68 vs. 5.02, p = 0.046) and Neuropsychiatric Inventory (NPI) (3.95 vs. 1.79, p = 0.018) compared with male patients. For dementia diagnosis, the clinician-rated MMSE and MoCA demonstrated sensitivities exceeding 90%, whereas the caregiver-rated Clinical Dementia Rating (CDR) had a sensitivity of only 25%. For depression, the clinician-rated HAM-D (88.5% sensitivity) outperformed the self-reported Beck's Depression Inventory II (BDI-II) (65.4% sensitivity). Most neuropsychiatric assessments were significantly correlated with age, disease duration, and motor severity.

These findings highlight a considerable neuropsychiatric burden in PD, with a distinct female-predominant vulnerability in cognitive and affective domains. The superior performance of clinician-administered assessments emphasizes their value in improving diagnostic certainty. These results support the routine, comprehensive, and sex-specific neuropsychiatric evaluations in the clinical management of PD.